Necrotizing Enterocolitis (NEC)

Ira Shah
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NEC - Investigations
- Serial X-rays of abdomen: Fixed bowel loop, appearance of mass, pneumatosis intestinalis, portal or hepatic venous air, pneumoperitoneum
- Stool examination: Occult blood, reducing substances for unabsorbed lactose, culture for aerobic/anaerobic bacteria
- Blood: Electrolytes, hematocrit, coagulation status, culture, ABG. Watch for triad of thrombocytopenia, severe refractory hyponatremia and acidosis.
- USG: Micro bubbles of gas in portal vein
- Hydrogen breath test


Medical Surgical
Respiratory : 
  • Supplement O2
  • Mechanical ventilatory support
CVS : 
  • Fresh frozen plasma
  • Low doses dopamine
Metabolic : 
  • NaHCO3
Nutrition : 
  • Stop oral feedings (7-14 days)
  • TPN instituted (90-110 cal/kg/d)
Antibiotics - For 7-14 days. Broad spectrum 

Hematological : 
  • Platelet transfusions
  • Packed RBCs
  • Vitamin K
CNS : 
  • Treat IVH, meningitis, seizures
Renal : 
  • Fluid therapy
Indications : 
  • Bowel perforation
  • Full thickness necrosis of bowel wall as evidenced by dilated loop of intestine unchanged in position > 24 hrs.
  • Peritonitis. Aspiration of brown colored fluid is indicative of intestinal gangrene.
Surgical treatment : 
Excision of necrotic area & end-to-end anastomosis


- Pneumonia & sepsis
- Surgical abdominal catastrophes
* Malrotation with obstruction
* Malrotation with midgut volvulus
* Intusussception
* Ulcer
* Gastric perforation
* Mesenteric vessel thrombosis
- Infections enterocolitis with diarrhea
- Inherited metabolic disease
- Feeding intolerance
- Systemic candidiasis


Necrotizing Enterocolitis (NEC) Necrotizing Enterocolitis (NEC) 01/07/2004
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